RESUMEN

The Emerging Adulthood is a complex and chaotic period and depression is one of the main psychological health problems during this period. Overgeneral autobiographical memory (OGM) is prevalent among patients with clinical depression. However, the prediction of OGM in groups with non-clinical depression and its influencing mechanisms remain inconclusive. Studies have shown that OGM and early parenting behaviour are vulnerable factors of depression in emerging adulthood, which may be triggered by negative life events. Our longitudinal study included 241 participants (Mage = 21.88 years). At baseline, participants completed measures of current negative life events, depression, early parenting behaviour and an autobiographical memory test. Thereafter, they were tracked for depression every 35 days. We used the latent class growth model to differentiate levels and trends of depression among non-clinical participants. The analysis showed that the effect of negative life events on depression was moderated by OGM and early parenting behaviour. However, this moderating effect was found only in the low-risk depression group. Our findings indicate that early parenting behaviour might account for the different mechanisms of OGM production in non-clinical groups. Moreover, it underlines the importance of OGM and early parenting behaviour as potential predictors of future depression in non-clinical groups.

RESUMEN

Apple tree productivity is influenced by the quantity of water and nutrients that are supplied during planting. To enhance resource utilization efficiency and optimize yields, a suitable strategy for supplying water and nitrogen must be established. A field experiment was conducted using a randomized block group design on five-year-old apple trees in Ningxia, with two irrigation lower limit levels (55%FC (W1) and 75%FC (W2)) and four N application levels (0 (N1), 120 (N2), 240 (N3), and 360 (N4) kg·ha-1). Our findings showed that leaf N content increased with a higher irrigation lower limit, but the difference was not statistically significant. However, the leaf N content significantly increased with increasing N application. The growth pattern of new shoots followed logistic curve characteristics, with the maximum new shoot growth rate and time of new shoot growth being delayed under high water and high nitrogen treatments. Apple yield and yield components (weight per fruit and number of fruits per plant) were enhanced under N application compared to no N application. The maximum apple yields were 19,405.3 kg·ha-1 (2022) and 29,607 kg·ha-1 (2023) at the N3 level. A parabolic relationship was observed between apple yield and N application level, with the optimal range of N application being 230-260 kg⸱ha-1. Apple quality indicators were not significantly affected by the irrigation lower limit but were significantly influenced by N application levels. The lower limit of irrigation did not have a significant impact on the quality indicators of the apples. Water and N utilization efficiencies improved with the W2 treatment at the same N application level. A negative relationship was observed between the amount of nitrogen applied and the biased productivity of nitrogen fertilizer. The utilization of nitrogen fertilizer was 127.6 kg·kg-1 (2022) and 200.3 kg·kg-1 (2023) in the W2N2 treatment. The apple yield was sustained, the quality of the fruit improved, and a substantial increase in water productivity was achieved with the W2N3 treatment. The findings of this study can be used as a reference for accurate field irrigation.

RESUMEN

Background: This study aims to investigate the relationship between older adults' perceived community services for the elderly (PCSE), life satisfaction (LS), and self-rated health (SRH). Methods: Data from four rounds of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 were used. A total of 2454 older adults were obtained. Unconditional Least Squares (ULS) was used to measure PCSE, LS, and SRH growth trajectories without covariates. Finally, a mediating latent growth model was constructed using Mplus 8.3 to examine the mediating role of LS in the relationship between PCSE and SRH after adjusting for some demographic characteristics. Results: The results from the ULS method indicate that the intercepts and slopes for PCSE and LS are significantly negatively correlated (ß 1 = -0.629, ß 2 = -0.579, p < 0.001). Additionally, there is a significant positive correlation between the intercept and slope of health levels (ß = 0.774, p < 0.001). Using a parallel growth model, significant regression coefficients were found between the intercept of PCSE and the intercepts of SRH and LS (ß 1 = -0.335, ß 2 = 0.378, p < 0.01). Similarly, the regression coefficients between the slope of PCSE and the slopes of SRH and LS were also significant (ß 1 = -0.532, ß 2 = 0.344, p < 0.01). Furthermore, the regression coefficient between the intercept of LS and the intercept of SRH was significant (ß = 0.415, p < 0.001). The regression coefficient between the slope of LS and the slope of SRH was also found to be significant (ß = 0.729, p < 0.001). Conclusion: It is essential to ensure adequate supply and accessibility of community services for older adults. LS especially is, and should be a promising target for assessing the quality of life and utilization of PCSE supply.

RESUMEN

BACKGROUND: Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor. METHOD: N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021. RESULTS: In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as pre-pandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory. CONCLUSIONS: IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.

Asunto(s)

RESUMEN

BACKGROUND: Nursing job competency is critical for talent development both globally and in China, relating to work readiness and transition shock. Previous studies, which have typically relied on average measurements at fixed time points, have not provided comprehensive longitudinal insights. AIM: This study aimed to investigate the developmental trajectories of transition shock in new nurses at oncology specialty hospitals. Furthermore, we sought to explore the longitudinal mediating role of transition shock in the relationship between work readiness and the development of nursing job competency. DESIGN: Longitudinal follow-up study. METHODS: We conducted three follow-up surveys over 8 months using the Work Readiness Scale, the Transition Shock Scale, and the Nursing Job Competency Scale to assess 252 novice nurses at two high-volume oncology centers. The surveys were conducted at 0, 4, and 8 months, with demographic information collected during the first survey. Data were analyzed using R 4.1.2 and Mplus 8.0. RESULTS: (1) Over the 8-month period, transition shock exhibited a linear decrease. Notably, nurses with a higher initial transition shock experienced a slower rate of decline. (2) There were positive correlations between work readiness and nursing job competency at all three measurement points. Conversely, transition shock was negatively correlated with both work readiness and nursing job competency. (3) Transition shock functioned as a longitudinal mediator in the relationship between work readiness and nursing job competency. CONCLUSION: This study clarified the longitudinal mediating role of transition shock in the relationship between work readiness and job competency in oncology settings. Targeted interventions are necessary to mitigate excessive transition shock, thereby improving the nursing job competency of new nurses in oncology hospitals. REGISTRATION: 23/313-4055.

RESUMEN

Introduction: Predicting the performance (yield or other integrative traits) of cultivated plants is complex because it involves not only estimating the genetic value of the candidates to selection, the interactions between the genotype and the environment (GxE) but also the epistatic interactions between genomic regions for a given trait, and the interactions between the traits contributing to the integrative trait. Classical Genomic Prediction (GP) models mostly account for additive effects and are not suitable to estimate non-additive effects such as epistasis. Therefore, the use of machine learning and deep learning methods has been previously proposed to model those non-linear effects. Methods: In this study, we propose a type of Artificial Neural Network (ANN) called Convolutional Neural Network (CNN) and compare it to two classical GP regression methods for their ability to predict an integrative trait of sorghum: aboveground fresh weight accumulation. We also suggest that the use of a crop growth model (CGM) can enhance predictions of integrative traits by decomposing them into more heritable intermediate traits. Results: The results show that CNN outperformed both LASSO and Bayes C methods in accuracy, suggesting that CNN are better suited to predict integrative traits. Furthermore, the predictive ability of the combined CGM-GP approach surpassed that of GP without the CGM integration, irrespective of the regression method used. Discussion: These results are consistent with recent works aiming to develop Genome-to-Phenotype models and advocate for the use of non-linear prediction methods, and the use of combined CGM-GP to enhance the prediction of crop performances.

RESUMEN

Individual modelling is a foundational approach to study the natural forest growth and in this paper, we develop a serial distance-depended individual tree model for some species in natural forest which would provide prediction and characteristics for natural species. The data used to develop individual model for natural mixed forests were collected from 712 remeasured 10-year periodic permanent sample plots of in Baihe Forest Bureau of Changbai Mountains, northeast China. Based on analyzing relationship between diameter increment of individual trees with tree size, competitive status, and site condition and finding out the major independent variables, the growth models for individual trees of 15 species in the natural mixed forests, that have good predicting precision, and easily applicable, were developed using stepwise regression method. The individual growth model developed in this study can reflect the tree increment of 15 species and be generally well suited for simulating tree and stand growth for natural mixed forests in Changbai Mountains. The research results for individual trees growth model of each species showed that main variable to influence on diameter increment of individual trees for natural mixed forests were tree size (D) and then competition index. The site condition was not related with diameter increment. The natural logarithm of DBH (lnD) and square diameter (D2) were included in the predicting models of diameter increment for all 15 species. The diameter increment was directly proportional to tree diameter for each species. For the competitive indexes in growth model, the relative diameter (RD), canopy closure (P), and the ratio of diameter of subject tree with maximum diameter (DDM) were related to diameter increment and the stand density measures were not significantly influenced on diameter increment. As canopy closure increase, tree increment decreases. The site conditions were performance less of factors in increment predictions in the model.

Asunto(s)

RESUMEN

BACKGROUND: Early embryonic aortic arches (AA) are a dynamic vascular structures that are in the process of shaping into the great arteries of cardiovascular system. Previously, a time-lapsed mechanosensitive gene expression map was established for AA subject to altered mechanical loads in the avian embryo. To validate this map, we investigated effects on vascular microstructure and material properties following the perturbation of key genes using an in-house microvascular gene knockdown system. RESULTS: All siRNA vectors show a decrease in the expression intensity of desired genes with no significant differences between vectors. In TGFß3 knockdowns, we found a reduction in expression intensities of TGFß3 (≤76%) and its downstream targets such as ELN (≤99.6%), Fbn1 (≤60%), COL1 (≤52%) and COL3 (≤86%) and an increase of diameter in the left AA (23%). MMP2 knockdown also reduced expression levels in MMP2 (≤30%) and a 6-fold increase in its downstream target COL3 with a decrease in stiffness of the AA wall and an increase in the diameter of the AA (55%). These in vivo measurements were confirmed using immunohistochemistry, western blotting and a computational growth model of the vascular extracellular matrix (ECM). CONCLUSIONS: Localized spatial genetic modification of the aortic arch region governs the vascular phenotype and ECM composition of the embryo and can be integrated with mechanically-induced congenital heart disease models.

RESUMEN

This paper establishes a fractional-order economic growth model to model the gross domestic product (GDP). The fractional-order model consists of a differential equation of integer and fractional orders, where the GDP is a function of several exploratory variables. An empirical application is adopted using Malaysia's GDP data from 1956 to 2018, incorporating exploratory variables such as total population, crude death rate, production of logs, gross fixed capital formation, exports of goods and services, general government final consumption expenditure, private final consumption expenditure, and the impact of investment. Extensive comparisons were carried out to evaluate the modelling performance of the full and reduced fractional-order multiple linear regression models with the benchmark models, namely full and reduced integer-order multiple linear regression models. Results indicate that the reduced fractional-order model with six exploratory variables, excluding the crude death rate and production of logs, predominates other models for the in-sample model fitting based on the Akaike information criterion, coefficient of determination and other criteria. Furthermore, the fractional-order model offers the best-of-sample forecasts evaluated based on the root mean square forecast error and mean absolute forecast error. The application of the Diebold-Mariano test also serves to confirm the superior performance of the suggested fractional-order model, revealing a significant difference in forecasting ability between the fractional-order and integer-order models.

RESUMEN

Objectives: To explore the timing of menarche, postmenarcheal growth, and to investigate the impact of various variables on menarcheal age and postmenarcheal and pubertal growth. Study Design: This longitudinal community population-based study analyzed pubertal growth and menarcheal age in 793 healthy term-born Swedish girls, a subset of the GrowUp1990Gothenburg cohort. The timing of menarche and postmenarcheal growth was related to variables from the Quadratic-Exponential-Pubertal-Stop (QEPS) growth model, birth characteristics, and parental height. Multivariable models were constructed for clinical milestones; at birth, age 7 years, pubertal growth onset, and midpuberty. Results: Menarche aligned with 71.6% (18.8) of the QEPS model's specific pubertal growth function, at a mean age of 13.0 (1.3) years, ranging from 8.2 to 17.2 years. Postmenarcheal growth averaged 8.0 (4.9) cm, varying widely from 0.2 to 31.1 cm, decreasing with later menarche. Significant factors associated with menarcheal age included height at 7 years, childhood body-mass index, parental height, and QEPS-derived pubertal growth variables. Multivariable models demonstrated increasing explanatory power for each milestone, explaining 1% of the variance in menarcheal age at birth, 8% at age 7 years, 44% at onset of pubertal growth, and 45% at midpuberty. Conclusions: This study underscores the strong link between pubertal growth and age at menarche. Data available at start of puberty explain 44% of the variation in menarcheal age, apparent on average 3.2 years before menarche. In addition, the study shows a previously seldom noticed wide variation in postmenarcheal height gain from 0.2 to 31.1 cm.

RESUMEN

Numerous contextual factors have been identified that impact the development of children's prosocial behavior, yet the influence of child-initiated factors on prosocial behavior and its underlying mechanism remains unclear. This study employed three longitudinal models to examine in depth how children's school engagement may promote the development of their own prosocial behavior. Three-wave longitudinal data from 4691 children (M age = 9.480, SD = 0.507; 48.2% female) with 2-year intervals were used. Sequentially, a cross-lagged panel model, a random intercept cross-lagged panel model, and a parallel process latent growth model were constructed. The findings indicated that children's school engagement consistently predicted the future level, dynamic changes at within-person level, and long-term trends in their prosocial behavior, and these longitudinal relationships were partially mediated by parental monitoring. These results reveal a child-parent synergistic mechanism for the development of prosocial behavior, wherein children's school engagement both directly promotes their own prosocial behavior and simultaneously enhances prosocial behavior through eliciting increased parental monitoring.

RESUMEN

The mean height is taller in males than in females, except for early teens. In this regard, previous studies have revealed that (1) distribution of the mean adult heights in subjects with disorders accompanied by discordance between sex chromosome complement and bioactive sex steroids and in control subjects (the British height standards) indicates that, of the ~12.5 cm of sex difference in the mean adult height, ~9 cm is accounted for by the difference in the sex chromosome complement and the remaining ~3.5 cm is explained by the dimorphism in sex steroids (primarily due to the growth-promoting effect of gonadal androgens); (2) according to the infancy-childhood-puberty growth model, the sex difference in the childhood growth function produces height differences of ~1 cm in childhood and 8-10 cm at 18-20 years of age, whereas the sex difference in the pubertal growth function yields height difference of ~4.5 cm at 18-20 years of age; and (3) SHOX expression and methylation analyses using knee cartilage tissues and cultured chondrocytes have shown lower SHOX expression levels in female samples than in male samples and methylation patterns consistent with partial spreading of X-inactivation affecting SHOX in female samples. These findings suggest that small but persistent sex difference in SHOX expression dosage leads to the variation in the sex steroid independent childhood growth function, thereby yielding the sex difference in height which remains small in childhood but becomes obvious in adulthood.

RESUMEN

Prior adaptation of Saccharomyces cerevisiae to the fermentation medium ensures its implantation and success in alcoholic fermentations. Fermentation kinetics can be characterized with mathematical models to objectively measure the success of adaptation and growth. The study aims at assessing and comparing two pre-culture procedures using, respectively, one or two adaptation steps, analyzing the impact of different initial glucose concentrations on the fermentation profiles of S. cerevisiae cultures, and assessing the performance of three predictive growth models (Buchanan's, modified Gompertz, and Baranyi and Roberts models) under varied initial glucose concentrations. We concluded that both protocols produced S. cerevisiae pre-cultures with similar viability and biomass increase, which suggests that short protocols may be more cost-effective. Furthermore, the study highlights the need of inoculating a high S. cerevisiae population to minimize the depletion of dissolved oxygen in the medium and to ensure that glucose is predominantly directed toward the ethanol formation at early fermentative steps. This study shows that the relationship between kinetic parameters is model-dependent, which hinders inter-study comparisons and stresses the need for standardized growth models. We advocate for the generalized use of confidence intervals of the kinetic parameters to facilitate objective inter-study comparisons.

RESUMEN

Staphylococcus aureus (Sa) and Acinetobacter baumannii (Ab) are frequently co-isolated from polymicrobial infections that are severe and refractory to therapy. Here, we apply a combination of wet-lab experiments and in silico modeling to unveil the intricate nature of the Ab/Sa interaction using both, representative laboratory strains and strains co-isolated from clinical samples. This comprehensive methodology allowed uncovering Sa's capability to exert a partial interference on Ab by the expression of phenol-soluble modulins. In addition, we observed a cross-feeding mechanism by which Sa supports the growth of Ab by providing acetoin as an alternative carbon source. This study is the first to dissect the Ab/Sa interaction dynamics wherein competitive and cooperative strategies can intertwine. Through our findings, we illuminate the ecological mechanisms supporting their coexistence in the context of polymicrobial infections. Our research not only enriches our understanding but also opens doors to potential therapeutic avenues in managing these challenging infections.

RESUMEN

The time-consuming nature of culturing methods has urged the exploration of rapid modern technologies. One promising alternative utilizes redox potential, which describes the oxidative changes within complex media, indicating oxygen and nutrient consumption, as well as the production of reduced substances in the investigated biological system. Redox potential measurement can detect microbial activity within 16 h, what is significantly faster than the minimum 24 h incubation time of the reference plate counting technique. The redox potential based method can be specific with selective media, but bacterial strains have unique kinetic pattern as well. The proposed method suggests evaluation of the curve shape for the differentiation of environmental contaminant and pathogenic microbial strains. Six bacterial species were used in validation (Escherichia coli, Pseudomonas aeruginosa, Salmonella enterica, Listeria innocua, Listeria monocytogenes, and Listeria ivanovii). Descriptive parameters reached 98.2 % accuracy and Gompertz model achieved 91.6 % accuracy in classification of the selected 6 bacteria species.•Mathematical model (Gompertz function) and first order descriptive parameters are suggested to describe the specific shape of redox potential curves, while Support Vector Machine (SVM) is recommended for classification.•Due to the concentration dependent time to detection (TTD), pre-processing applies standardization according to the inflection point time.

RESUMEN

The prevention and control requirements for HIV/AIDS vary significantly among different populations, posing substantial challenges to the formulation and implementation of intervention strategies. Dynamically assessing the heterogeneity and disease progression trajectories of various groups is crucial. Latent class growth model (LCGM) serves as a statistical approach that fits a longitudinal data into N subgroups of individual development trajectories, identifying and analyzing the progression paths of different subgroups, thereby offering a novel perspective for disease control strategies. LCGM has shown significant advantages in the application of HIV/AIDS prevention and control, especially in gaining a deeper understanding and analysis of epidemiological characteristics, risk behaviors, psychological research, heterogeneity in testing, and dynamic changes. Summarizing the advantages and limitations of applying LCGM can provide a reliable basis for precise prevention and control of HIV/AIDS.

Asunto(s)

RESUMEN

BACKGROUND: The importance of parent-teacher relationships has been well-discussed in Western contexts. It's still unclear whether and how parent-teacher relationships affect students' academic development, especially in the context of China's uneven development between urban and suburban areas. AIMS: This study examined the urban-suburban differences in the influence of the parent-teacher relationships on students' learning engagement during the last 3 years of primary school to contribute to related policy and practice. SAMPLE AND METHODS: Data were collected annually during the summer period in three waves from Grades 4 to 6. The sample included 1408 students (Mage = 10.35, SD = .48; 49.1% boys) paired with their mothers (Mage = 38.82, SD = 3.54), with 643 pairs from urban areas and 765 pairs from suburban areas in China. In each wave, the parents reported the frequency of contact with their child's teacher during the previous school year as well as the quality of their relationship, and the students reported their learning engagement. Latent growth models were used to examine the hypotheses. RESULTS: A statistically significant decline in learning engagement was seen only in suburban students, while the parent-teacher relationships seemed to increase for both suburban and urban participants. Latent growth modelling showed that the increasing levels of relationship quality reduced the decline in the suburban students' learning engagement, although the contact between parents and teachers did not play such a positive role for both urban and suburban students. CONCLUSIONS: The findings reveal a compensatory effect of the quality of the parent-teacher relationship on suburban students' learning engagement. Considering the difference in students' learning engagement between urban and suburban students, increased effort on high-quality parent-teacher relationships for suburban students is required to better support their academic development.

Asunto(s)

RESUMEN

Public health events (PHEs) have emerged as significant threats to human life, health, and economic growth. PHEs, such as COVID-19, have prompted a reevaluation for enhanced regular prevention and control (RPC). In this study, we focus on the core concept of prevention and control intensity (PCI), and establish a neoclassical economic growth model from the long-term and macro perspective to balance life protection and economic growth. The model construct the mechanism of PCI on economic growth through population dynamics and capital accumulation under the backdrop of RPC for PHEs. We find the conditions for PCI when the economy achieves steady state, and provides an algorithm establishing the optimal strategy that maximises per capita disposable income based on the optimal PCI and consumption. Simulation result quantifies an inverted U-shaped relationship between PCI and capital per capita, output per capita and consumption per capita in the steady state. The model suggests that, given the PHEs of inducing potential unemployment shock, it is worthwhile to combine the implementation of moderate PCI with coordinated policies of income distribution.

Asunto(s)

RESUMEN

PURPOSE: This study aims to explore heterogeneous trajectories of psychosocial adjustment among young to middle-aged women with breast cancer and determine the predictive factors influencing these trajectories. METHODS: This study was conducted from October 2019 to October 2022 across two hospitals in Guangzhou. Demographic and disease characteristics, psychosocial adjustment, self-efficacy, social support, and coping modes were collected at baseline. Follow-up evaluations of psychosocial adjustment occurred at 1, 3, and 6 months post-surgery. Latent class growth modeling identified distinct patterns of psychosocial adjustment trajectories. Logistic regression analysis determined the predictive factors. RESULTS: A total of 377 young to middle-aged women with breast cancer participated in this study, with 289 participants completing the 6-month follow-up. Three distinct trajectories of psychosocial adjustment were identified including a "sustained severe maladjustment" trajectory, comprising 22.5% of participants, a "sustained moderate maladjustment" trajectory, comprising 50.4% of participants, and a "well-adjusted class" trajectory, comprising 27.1% of participants. Predictors of psychosocial adjustment trajectories included affected side, surgical type, chemotherapy, self-efficacy, social support, and coping modes. CONCLUSIONS: This study revealed three distinct trajectories of psychosocial adjustment among young to middle-aged women with breast cancer. Those with right-sided breast cancer, undergoing total mastectomy, receiving chemotherapy, low self-efficacy, limited social support, and relying on confrontation or avoidance coping modes may experience sustained maladjustment.

Asunto(s)

RESUMEN

OBJECTIVE: To explore the potential categories and influencing factors of fatigue trajectory in maintenance haemodialysis patients. METHODS: Between June 2023 and December 2023, a convenience sample of 306 maintenance haemodialysis patients in a tertiary hospital haemodialysis centre in Zhenjiang City was selected as the study population, and patient information was collected monthly after the baseline survey using the General Information Questionnaire, Pittsburgh Sleep Quality Scale, Piper Fatigue Revision Scale, Collaborative Social Support Scale, Patient Health Questionnaire Depression Scale, Comprehensive Economic Toxicity Rating Scale, and Fear of Disease Progression Simplified Scale, for a total of six follow-up visits. In addition, the potential category growth model was used to identify the developmental trajectory of fatigue, and univariate analysis and binary logistic regression were used to analyse its determinants. RESULTS: The 6 month fatigue trajectory of maintenance haemodialysis patients could be divided into two categories: persistent low-fatigue group (59.8%) and fluctuating high-fatigue group (40.2%). Age, surgical history, level of social support, sleep, economic toxicity, and changes in ultrafiltration volume during dialysis were the influencing factors for repeated fatigue in maintenance haemodialysis patients (p < 0.05). CONCLUSION: The fatigue trajectory of maintenance haemodialysis patients is heterogeneous, suggesting that clinical workers should focus on the haemodialysis patients with repeated fatigue and make targeted interventions to improve their fatigue status and reduce the occurrence of adverse events in patients.